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General NPI Number Information
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NPI Number | 1144135625
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Entity Type | Organization
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Legal Business Name | VIVACITY 360 HEALTH CO
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 116 N LIVERMORE ST
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City | HAZEN
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State | AR
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Zip | 72064
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Country | US
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Telephone | 501-232-1107
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Fax | 501-426-8339
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Provider Business Mailing Address
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Address Line | 2342 HIGHWAY 31 N
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City | BEEBE
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State | AR
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Zip | 72012-9780
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Country | US
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Telephone | 501-232-1107
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Fax | 501-426-8339
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Authorized Official
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Title or Position | CEO
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Name | MRS. CANDICE ANN FORTE
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Credential | APRN
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Telephone | 501-954-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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